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Science eyes OCs for ovarian endometriomas
While surgery is the most accepted method for treating ovarian endometriomas, recurrence often is recorded. Results from newly published research, which evaluates use of cyclic and continuous administration of oral contraceptives post surgical removal, indicate that Pill use can effectively reduce and delay endometrioma recurrence. 1
If the use of an oral contraceptive pill (OCP) is considered to reduce the risk of recurrence of an endometrioma after laparoscopic cystectomy, treatment should be given for at least two years, advises Neil Johnson, MD, associate professor at the University of Auckland in New Zealand and medical director of Fertility Plus, an Auckland fertility clinic. Johnson is co-author of a review of the current study's results.2
Ovarian endometriomas may develop from ovarian corpus luteum formation;3 by inhibiting ovulation with Pill use after surgical removal, the risk of developing further endometrioma may be reduced, says Johnson.
Andrew Kaunitz, MD, professor and associate chair in the Obstetrics and Gynecology Department at the University of Florida College of Medicine – Jacksonville, says, "This report adds to the literature indicating the benefits of hormonal management in women who have undergone surgery for endometriosis. The same group has previously shown that postoperative use of continuous oral contraceptives reduces dysmenorrhea in women who have undergone surgery for endometriosis."4
To perform the study, researchers looked at 239 patients who were scheduled to undergo laparoscopic excision of an ovarian endometrioma of at least 4 cm in size on ultrasound. Women included in the study were nulliparous, ages 20-40, and not attempting to conceive for at least two years post-surgery. Following the surgical intervention, women were randomized into one of three groups:
Of the 239 women enrolled in the study, 217 completed the study (69 non-users, 75 cyclic users, and 73 continuous users). Follow-up was performed for at least 24 months, where recurrence, recurrence rate, recurrence-free survival, and size and rate of growth of recurrent cysts were documented.
The scientists recorded 37 endometrioma recurrences during follow-up, with 29% in the non-users, 14.7% in the cyclic OCP users, and 8.2% in the continuous OCP users. The results indicate a "significant" reduction in recurrence-free survival in users versus non-users, with no significant differences detected between the cyclic and continuous groups for the whole follow-up period.2 The mean diameter of endometriomas was significantly smaller and the endometrioma growth was reduced in the OCP users compared to non-users, reviewers note.2
What is the most effective period for Pill use for postoperative results following endometrioma removal? Studies to date provide conflicting results on postoperative OCP use, reviewers note.2
Researchers in previous trials have looked at shorter duration of pill administration. In a prospective, randomized trial of 70 patients ages 20-35 who were not attempting to conceive, underwent laparoscopic excision of ovarian endometriomas, followed by postoperative administration of low-dose cyclic oral contraceptives for six months or no treatment on the basis of a computer-generated sequence. At three and six months after surgery and then at six-month intervals, both groups underwent ultrasonographic examination for possible evidence of endometrioma recurrence and for evaluation of the absence, persistence, or recurrence of pain symptoms. No benefit was found in the long-term recurrence rates at both 24 and 36 months, but a positive effect was seen at 12 months.5
Scientists who designed a retrospective study looked at Pill use for 9.5 months.6 The study included 224 patients who had a minimum of two years of post-operative follow-up after laparoscopic ovarian endometrioma excision. While no benefit was seen, researchers hypothesized that a longer-term treatment period might be useful. Results from a cohort study published in 2008 supported this hypothesis.3 Scientists saw a reduction in recurrence at 36 months follow-up.
What is the next step in research? Scientists in the current 2010 study say that further studies are required, especially to look at the effect of oral contraceptive use on the recurrence of symptoms, as well as weigh the potential advantages that continuous OCP use might have over cyclical Pill administration.2